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Time for reshaping care to shape up

In the light of a report, published today, on Government plans to shift older people’s health and social care more from hospitals into communities, Age Scotland Chief Executive Brian Sloan addresses the challenges and likely solutions.

It’s also a myth that most older people need expensive care; in fact, the reverse is true: most older people do not. Only 9 per cent of over-65s are in long-term residential care or receive formal care at home; even among over-85s, this figure rises to just over a third (although many more people receive informal support from relatives).

Nonetheless, our changing demographics will have profound consequences. The ways in which our society pays for retirement, and the houses in which older people live, will have to adapt. Similarly, we cannot assume that traditional models of planning and delivering health and social care will continue to work. That’s what the Reshaping Care for Older People programme is supposed to be about. It aims to shift the balance of care, with more support delivered in homes and in communities than in hospitals. If we do this, we will also make it more likely that older people will remain physically active and socially connected, and achieve better health outcomes. We will also save public money, as resources can be diverted from expensive and reactive hospital treatment to more proactive and cost-effective care within communities.

The ambition is easy to state, but complex to achieve. NHS boards, local authorities and health and social care partnerships need to develop and implement change, at the same time as meeting current demands. It is always challenging to make direct links between preventative support and savings, many of which will not be seen until much later. The health service and councils currently work to different aims and standards; greater integration should help here, but there still needs to be a profound shift in culture, and a relentless focus on older people’s rights and better outcomes over the mechanics of getting things done.

Today, the public scrutiny body Audit Scotland has published a report which shows how much more needs to be achieved.

Because real change will involve many different people and organisations, there needs to be a firm commitment and strong leadership, both nationally and locally, to drive progress. The NHS and local councils need to develop strategic plans which promote consistency and reduce unnecessary variation.

We need to be more open to innovative and collaborative solutions: GPs should be more open to social prescribing or community referrals; care managers and care providers need to think about creative ways to address and manage the social effects of long-term health conditions; there should be an established process to decide whether someone really needs to be admitted to hospital or if community or home-based support can be arranged.

The report also notes that, although there are examples of good practice in linking up care and treatment towards more preventative and anticipatory approaches, there is no nationwide monitoring system to track progress or help to determine what is working and could be scaled-up and extended. The Scottish Government has invested £300 million over four years through the Change Fund to help push this, which has made different organisations develop some joint objectives, but investment decisions seem unsystematic and disconnected and projects are often not evidence-based. A central focus on the outcomes achieved locally would be a vital step, especially as joint strategic commissioning plans are being developed locally over the next year.

The reshaping care programme is intended to last until 2021, so there is time to reflect on the work, much of it good, which has already been done. But a protracted, piecemeal approach won’t work for such a mammoth change, on which so many of the older people of tomorrow will depend.